Peeraully Riyad, Langley Jason, Hayes Nicola, Storry Kate, Richardson Louise, Burridge Demelza, More Bharat
Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Pediatr Surg Int. 2022 Jun;38(6):883-889. doi: 10.1007/s00383-022-05122-1. Epub 2022 Apr 8.
Analysis of outcomes and follow-up of children who underwent the Malone antegrade continence enema (MACE) procedure in a UK tertiary paediatric surgery unit.
Children who underwent a MACE procedure from 1998 to 2020 were identified. Demographic and clinical data were obtained from contemporaneous records. Outcomes were categorised as full (success), partial or failure.
Ninety-five children were identified for inclusion (chronic idiopathic constipation (CIC, 59), anorectal malformations (ARM, 23) and Hirschsprung's disease (HD, 13)). Mean age at surgery was 9.4 years (3-19 years) and mean follow-up time was 6 years (0.3-16.8 years). Outcomes were successful in 69% of CIC patients, 78% in ARM and 69% in HD. Twenty (21%) underwent MACE reversal after developing independent continence, with a significant difference between groups (CIC 19%, ARM 9%, HD 54%, p = 0.0047). 50% of patients > 16 years old were transitioned to adult services.
We report a success rate of 72% for MACE procedures in our unit, with a significant difference in reversal rate between diagnostic groups. Long term, a fifth of patients no longer required their MACE. When these patients reach adolescence, those who require ongoing support outside of the paediatric surgery setting should be safely transitioned to adult services.
分析在英国一家三级儿科手术科室接受马龙顺行性节制灌肠术（MACE）的儿童的手术结果及随访情况。
确定1998年至2020年期间接受MACE手术的儿童。从同期记录中获取人口统计学和临床数据。结果分为完全成功、部分成功或失败。
确定纳入95名儿童（慢性特发性便秘（CIC，59例）、肛门直肠畸形（ARM，23例）和先天性巨结肠病（HD，13例））。手术时的平均年龄为9.4岁（3 - 19岁），平均随访时间为6年（0.3 - 16.8年）。CIC患者的成功率为69%，ARM患者为78%，HD患者为69%。20例（21%）在建立自主控便后接受了MACE手术逆转，各诊断组之间存在显著差异（CIC为19%，ARM为9%，HD为54%，p = 0.0047）。50%年龄大于16岁的患者转诊至成人医疗服务机构。
我们报告本科室MACE手术的成功率为72%，各诊断组的逆转率存在显著差异。长期来看，五分之一的患者不再需要MACE手术。当这些患者进入青春期时，那些在儿科手术环境之外仍需要持续支持 的患者应安全转诊至成人医疗服务机构。
